Looking Beyond CTE

In recent news there has been a lot of attention focused on Chronic Traumatic Encephalopathy (CTE). Every day, we learn more and more professional athletes (NFL, NHL, Professional Wrestling, Professional Soccer) that have suffered repeated concussions are now suffering disabling symptoms such as depression, sleep disorders, anxiety disorders, as well as memory and concentration problems (cognitive impairments).

Most of the well-publicized incidences involve NFL players. Increasingly, we hear of former NFL players that are suffering these symptoms in their 30’s, 40’s and 50’s. Some take their own lives in horrific acts of suicide. Others have even taken the lives of their family members before they commit suicide.

The common denominators are:
1. They were former professional athletes;
2. They suffered repeated concussions;
3. They began to suffer symptoms of cognitive decline and impairment and psychiatric issues while much younger than those who typically suffer overlapping symptoms due to Alzheimer’s.

Yet the media consistently fails to fully comprehend that:

1. Chronic Traumatic Encephalopathy (CTE) is only one possible outcome from suffering Traumatic Brain Injuries (TBI) such as concussive, or sudden acceleration/deceleration, forces to the brain. We know that professional athletes that play in the NFL or NHL are at great risks of suffering Traumatic Brain Injury (TBI).

2. The real and ultimate damage to the brain is often due to the brain suddenly moving back and forth (sudden acceleration and deceleration) within the skull, and not due to actual blows to the head, as most would have you believe or misunderstand.

3. Sudden acceleration and deceleration of the brain can cause debilitating symptoms of Traumatic Brain Injury (TBI) such as cognitive impairment and psychiatric issues without resulting in Chronic Traumatic Encephalopathy (CTE). It just happens that CTE is one of the more severe and identifiable consequences of Traumatic Brain Injury (TBI). The reason that CTE is more identifiable includes the findings of Tau protein within the brains of those suffering CTE.

4. We must stop thinking that Chronic Traumatic Encephalopathy (CTE) is the only permanent brain damage from sudden acceleration and deceleration of the brain. This violent movement can and often does cause mild Traumatic Brain Injuries (mTBI) by causing Diffuse Axonal Damage (DAI) or Traumatic Axonal Damage (TAI). Symptoms of depression, anxiety, sleep disorder, and cognitive impairments such as short term memory problems, concentration impairments and decision making impairments are often related to Diffuse Axonal Damage (DAI) or Traumatic Axonal Damage (TAI). A person can suffer Diffuse Axonal Damage (DAI) or Traumatic Axonal Damage (TAI), and all of the resulting debilitating effects, without ever suffering from CTE.

5. Trying to understand why some former professional athletes suffer Traumatic Brain Injury (TBI) and wind up with Chronic Traumatic Encephalopathy (CTE), while others that play the same sport do not, is like trying to understand why everyone that smokes does not develop cancer. It is a pointless exercise and basically impossible due to a myriad of factors, including genetics, the exact types of concussions, the proximity of repeated concussions to each other, the nature and location of the resulting lesions, etc.

Many articles about CTE question whether psychiatric and/or cognitive impairment is due to CTE or other possibilities such as Alzheimer’s Disease. In order to determine whether cognitive impairments and/or psychiatric issues are causally related to TBI or Alzheimer’s, we need only consider the age of the athlete. Approximately 95% of people who suffer from Alzheimer’s are 65 and older. The fact that these athletes are significantly younger when they start to suffer symptoms should rule out Alzheimer’s. But given that athletes have often been playing Junior High, H.S., college, and professional football (15-20 years on average) and have suffered multiple concussions along the way should conclusively rule out Alzheimer’s.

It’s silly to consider Alzheimer’s as a possible explanation for those suffering TBI and its sequelae, even in those cases that do not result in CTE.

Concussion Fears Awakening within the NFL

On Wednesday this past week, A.J. Tarpley of the Buffalo Bills, announced that he was retiring from the NFL. What is more surprising is that he is only 23 years old. Tarpley, a linebacker for the Bills, gave the reason for this retirement as concerns for his long term health due to repeated concussions aka known as mild traumatic brain injury. He is the youngest player to retire from the NFL. Chris Borland, of the San Francisco 49ers also left recently after one season due to his fear of long-term brain damage from mild traumatic brain injury aka concussions leading to cognitive deficits and impairments. Hussain Abdullah retired in March of this year after suffering several concussions (mild traumatic brain injuries) in his 7 years with the NFL. Chronic Traumatic Encephalopathy (C.T.E.), a brain disease with severe cognitive impairments resulting from repeated mild traumatic brain injuries aka concussions, has been detected in the brains  of several retired players including quarterbacks like Ken Stabler of the Raiders. When asked for his comment about the sport and it’s dangers of lasting brain damage, Commissioner Goodell stated: “If I had a son, I’d love to have him play the game of football. He also said: “There’s risk in life. There’s risk in sitting on the couch.”

Helping our Community of Clients

A few weeks ago we received a call from one of our former clients who had recently received a notice to appear in court from his landlord. Mr. B. has been living with his family in their Queens apartment for 15 years since they arrived in the U.S. and called our office very worried about the possibility of having to uproot them. His landlord brought an action against him in Queens Housing Court to compel Mr. B to surrender possession of his apartment based on his lease having expired and their unwillingness to renew it. One of our paralegals did some research on housing law, accompanied the client to his hearing, and was able to help Mr. B come to an agreement with his landlord and remain in his apartment.

One of the most important things here at NL is that our clients, and even former clients, know their rights. We strive, not only to fight for our clients, but also to help them navigate other hurdles that may arise, sometimes as a result of their case.

We also make it a point to maintain open communication with our clients, and former clients. They trust us to have their best interests at heart. Our client community knows we have their back.

Functional MRI (FMRI)

FMRI has been around for many years now. It is no longer experimental. Yet, it is our opinion that the insurance industry and their legions try to keep the technology from becoming mainstream in investigating brain dysfunction and other diseases.

FMRI shows certain areas of the brain ‘lighting up’ during activity controlled by corresponding areas. FMRI can be used to detect inactivity as well. Inactivity where we would expect to see “lighting up” can represent physiological damage to that part of the brain. FMRI is sensitive to the functions of the brain whereas conventional MRIs only investigate structural damage to the brain, albeit on a very superficial level. Conventional MRIs will usually not detect axonal damage; hence the need for DTI (Diffuse Tensor Imaging) MRIs that measure deviations in water diffusion along the axons to detect structural damage to their myelin sheaths.

With most mild Traumatic Brain Injury (mTBI), the patient complains of clinical symptoms such as headaches, dizziness, concentration difficulty, memory impairment, anxiety, depression and sleep disorder after a traumatic event and yet there is no radiological proof of the brain damage. The typical neurologist sends the patient for a conventional CT or MRI to see if there are any bleeds or lesions. When the MRI comes back normal, the neurologist diagnoses a concussion and explains that the patient is experiencing Post Concussion Syndrome (PCS) and that he or she will get better within a few months. Some patients continue to suffer from ongoing cognitive deficits (e.g. concentration, memory, reading), emotional irregularity (e.g. depression, anxiety), physical symptoms (e.g. headaches, sleep disorder, dizziness, nausea, syncope, light sensitivity) and other sensorial deficits (e.g. smell, taste) for an indefinite period of time This leads to their lives falling apart. They can no longer function at work. They can no longer engage with their friends and family.

So the patient continues to experience and complain of clinical symptoms but the neurologist has exhausted his or her conventional toolbox. Some more contemporary educated neurologists will send their patient for a NeuroPsychological Evaluation (NPE). But an NPE is still a clinical evaluation, although a much more sensitive psychometric standardized test to measure brain functions than a Gross Mental Status exam.

In a lawsuit to recover damages for a mild Traumatic Brain Injury, the defense and insurance industry typically defend by saying that the patient is purposefully answering the NPE incorrectly as part of their malingering (faking) and secondary gain (money) motives. These defenses can be convincing to a conservative and skeptical jury.

Therefore, without further radiological proof or neuro-imaging, the jury may be fooled into believing that the Plaintiff did not suffer mild Traumatic Brain Injury (MTBI).

Two types of sensitive neuro-imaging tests can help in the investigation of brain damage in mild TBI cases.

The first type is structural — to see if there is damage, such as axonal damage that cannot be seen in conventional MRIs or CTs. DTI is the most sensitive study to assess axonal damage — which is probably present in 99% of mild Traumatic Brain Injury (mTBI) cases.

The second type of neuro-imaging is functional – to see if parts of the brain are functioning normally. PETs, FMRIs, and qEEG are the neuro-imaging functional diagnostic tests used to assess brain functions.

Of course, these tests are expensive and the greedy insurance companies want these tests to stay out of mainstream evaluations since they will further corroborate clinical symptoms and allow for more treatment. Most scientists that are not beholden to insurance companies know that there is so much about the brain we do not yet understand. They realize that a brain that looks normal on conventional imaging studies in a patient that can pass a Gross Mental Status exam may still be seriously injured and cause a host of clinical problems that can have a devastating effect to the person’s life.

Hidden Brain Injury Dangers in Pee Wee Football

Recently, a lot of attention has been given to Traumatic Brain Injuries (TBI) occurring in professional sports such as the NFL and NHL as well college level football. This past year, there have been numerous deaths, though not all related to Traumatic Brain Injury (TBI), from playing high school football. It is quite ignorant of us: the doctors, the lawyers and those leaders and administrators that are involved with tackle football leagues for younger players all the way down to the Pee Wee level, to believe that the dangers of brain injury are not relevant to younger players since there is less force involved.

In 2009, the chief neuropathologist at Boston University, who has been leading the investigation into Chronic Traumatic Encephalopathy (CTE) – a condition caused by repeated concussions that lead to brain tissue death – among professional athletes including those in the NFL and NHL, said that injuries to developing brains can have a far more detrimental effect than injuries to fully developed adult brains.

This means that a child who plays tackle football at the Pee Wee Level (ages 8-12) can suffer a more serious brain injury than an adult since the child’s brain is still developing.

We, at Nguyen Leftt, have always believed that the main cause of Traumatic Brain Injuries cannot be prevented by a football helmet. While the helmet may protect the player’s face and skull from trauma, it cannot protect the brain from the sudden acceleration and deceleration force attendant in violent contact sports such as tackle football and hockey.

We also believe that giving a child a helmet and other protective gear will give the child a false sense of belief that he is protected from traumatic brain injury. This false sense of protection will allow him to think he can hit harder than he would without a helmet. This is the added danger in the sport of tackle football. Not only is tackle football an inherently dangerous activity, the requirement of wearing a helmet ironically increases the danger.

Another hidden danger that we at Nguyen Leftt see is that the weight of a heavy football helmet on a boy’s head adds to the speed of the sudden acceleration and deceleration of the brain. If we are to think of the spine as a whip and the tip of the whip is the head. The speed of the whip is fastest at the tip- the head. Now add weight to the tip/head and the tip/head moves faster during the whiplash movement of the spine. It’s common physics Force x Mass = Velocity. Increase the mass and the speed/velocity increases.

We believe that neither the parents nor child players are educated or warned about the inherent dangers of tackle football and that no helmet will protect from traumatic brain injuries. In the case of our client, who was playing Pee Wee tackle football at the time he suffered a severe concussion, he was wearing full protective gear. When we looked at the website of the manufacturer of the helmet he was wearing at the time he suffered his severe concussion, what we found out was before you can enter the website, a window pops up exclaiming:  “NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.”

Among other thoughts, we at Nguyen Leftt believe that leagues allowing young children with developing brains to engage in a sport that even the helmet manufacturer acknowledges are inherently dangerous must be held responsible whenever a child suffers an injury from engaging in tackle football. These leagues must warn and educate all parents and children of the inherent dangerous nature of tackle football.

Moreover, we think that a warning posted on a website of manufacturers who profit from selling helmets to tens of thousands of children is not sufficient to advise parents and children of the “protective gears” inability to protect our childrens’ brains.